matter , the ETT cuff should still be inflated and the tube manually cleaned first . It is important to ensure the manufacturer ’ s label is read and understood . The author ’ s practice uses an enzymatic solution which , if well maintained , can be kept and used for up to 7 days but should be changed when it becomes cloudy or contaminated . The ETT should be soaked for the instructed amount of time , rinsed and placed into a high-level instrument disinfectant solution ( if available ). Here , it undergoes both bactericidal and fungicidal protection . The solution should be refreshed after 7 days ( Figure 11 ).

Figure 9b . Dry debris on the inflated cuff due to improper cleaning .

Cleaning of ETTs

As ETTs are exposed to non-sterile mucosa , they should ideally be sterilised . However , due to the material from which they are made , they are heat sensitive and cannot be autoclaved , so instead require a high level of disinfection . If an ETT has been used for an infectious patient , it should either be sterilised using ethylene oxide ( if it is available ) or disposed of ( Murrell & Ford- Fennah , 2020 ). Tubes should then be thoroughly rinsed and properly dried before being reused . If a high-level disinfectant is not available then thorough cleaning using a detergent with enzymatic action should be performed , or washing-up liquid with water may also be used ( Bradley , 2015 ).

The first step is to inflate the ETT cuff and manually rinse and wipe away any debris , mucus and fluid that may be on the tube . Long thin brushes can be pushed into the tube and down the lumen to remove any material inside the tube ( Figure 10 ).

The tube can then be placed into an enzymatic instrument and cleaning solution that is designed to dissolve and further remove proteinaceous and organic matter , such as saliva , blood and mucus . Although this solution is designed to remove the organic

Figure 11 . Label solutions with the date to ensure they are not kept for more than 7 days .

Figure 10 . Use brushes to clean the inside of ETTs .

56 Veterinary Nursing Journal